Sugar pills
relieve pain for chronic pain patients
Northwestern University
Someday doctors may prescribe sugar
pills for certain chronic pain patients based on their brain anatomy and
psychology. And the pills will reduce their pain as effectively as any powerful
drug on the market, according to new research.
Northwestern Medicine scientists
have shown they can reliably predict which chronic pain patients will respond
to a sugar placebo pill based on the patients' brain anatomy and psychological
characteristics.
"Their brain is already tuned
to respond," said senior study author A. Vania Apkarian, professor of
physiology at Northwestern University Feinberg School of Medicine. "They
have the appropriate psychology and biology that puts them in a cognitive state
that as soon as you say, 'this may make your pain better,' their pain gets
better."
"You can tell them, 'I'm giving
you a drug that has no physiological effect but your brain will respond to
it,'" he said. "You don't need to hide it. There is a biology behind
the placebo response."
The study was published Sept. 12
in Nature Communications.
The findings have three potential
benefits:
Prescribing non-active drugs rather
than active drugs. "It's much better to give someone a non-active drug
rather than an active drug and get the same result," Apkarian said.
"Most pharmacological treatments have long-term adverse effects or
addictive properties. Placebo becomes as good an option for treatment as any
drug we have on the market."
Eliminating the placebo effect from
drug trials. "Drug trials would need to recruit fewer people, and
identifying the physiological effects would be much easier," Apkarian
said. "You've taken away a big component of noise in the study."
Reduced health care costs. A sugar
pill prescription for chronic pain patients would result in vast cost savings
for patients and the health care system, Apkarian said.
How the study worked
About 60 chronic back pain patients
were randomized into two arms of the study. In one arm, subjects didn't know if
they got the drug or the placebo. Researchers didn't study the people who got
the real drug.
The other study arm included people who came to the clinic but didn't get a placebo or drug. They were the control group.
The other study arm included people who came to the clinic but didn't get a placebo or drug. They were the control group.
The individuals whose pain decreased
as a result of the sugar pill had a similar brain anatomy and psychological
traits.
The right side of their emotional brain was larger than the left, and they had a larger cortical sensory area than people who were not responsive to the placebo. The chronic pain placebo responders also were emotionally self-aware, sensitive to painful situations and mindful of their environment.
The right side of their emotional brain was larger than the left, and they had a larger cortical sensory area than people who were not responsive to the placebo. The chronic pain placebo responders also were emotionally self-aware, sensitive to painful situations and mindful of their environment.
"Clinicians who are treating
chronic pain patients should seriously consider that some will get as good a
response to a sugar pill as any other drug," Apkarian said. "They
should use it and see the outcome. This opens up a whole new field."